4/9/2015 Cardio-Oncology for the Primary Care Provider as a result of the treatment. Barry W. Ramo, MD,FACC New Mexico Heart Institute April 11, 2015 what is the least likely cause of death for a patient who has survived one cancer? 1. Cancer 2. Heart Disease what is the most likely cause of death for a patient who has survived cancer? 1. Cancer 2. Heart Disease Cancer patients are cured of one life-threatening disease, only to succumb to another — heart failure — 1 4/9/2015 Cardiac Care of Patients with Cancer CV Evaluation, Risk Factors Survival Cancer Diagnosis. Cytotoxic Rx Targeted XRT Cardiac Care • Cardiac • CV Toxicity disease • Strain • Premature ,EF,Biomar death ker • MRI Primary Care Provider Role in Caring for their Patients with Cancer  Diagnosis  During Therapy  Post Therapy Therapeutic and Cardiotoxic Agents Type 1 Anthrcyclines Type 2 Herceptin TARGETED THERAPY • Tyrosine Kinase inhibitors • VEGF Inhibitors 2 4/9/2015 Conflicting Goals Maximize therapeurtic benefit Kill the Prevent cancer Cancer therapeutics related cardiac dysfunction (CTRCD) Detection of Early Toxicity • Biomarkers: BNP, Troponin • Left ventricular dysfunction • Cardiac MR Detection of Risk for Deterioration of Cardiac Function after anthracyclines and Herceptin • Predictors at 3 months HS Troponin Myocardial strain • Not Predictive • BNP • Ejection Fraction 3 4/9/2015 Prevention of Cardiotoxicty • Limited Data • Beta Blocker, ACE-I combination in small studies reduced LV dsyfunction Iib recommendation OVERDRIVE: EnalapriI + Carvedilol With intensive Chemotherapy . N=90 Mortality 6% Mortality 22% 6.2% 33% Cardiac Care of Patients with Cancer CV Evaluation, Risk Factors Cardiac Care Survival Cancer Diagnosis. Cytotoxic Rx Targeted XRT • • • Cardiac Toxicity Strain ,EF,Bioma rker MRI • Late heart failure • HBP • Optimize Risk Factors 4 4/9/2015 Thank You 5